In theory, generics should lower the costs of treatment by making a lower cost substitute to a brand name available.

In recent years, the Food and Drug Administration (FDA) has made getting more generic drugs on pharmacy shelves a priority. This should eventually reduce drug prices, the agency and outside experts have said.

That was the hypothesis Daniel Hartung, MPH, and his fellow researchers at Oregon State University had, too.

The College of Pharmacy professor says they’ve been working on tracking MS drug prices for the past 5 years.

“Like many other classes of drugs,” Hartung told Healthline, “prices have gone up and continue to go up on yearly basis.”

A generic version of Copaxone, one of the more common MS treatments, was introduced in 2015.

Hartung says that after prices went up quickly from 2000 to 2015, price increases had slowed down a bit in the past 5 years, likely due to increased public scrutiny.

“So, the hypothesis was that perhaps the introduction of a generic would moderate the price increases even more,” he said. “But we found it didn’t seem to have an effect on the continued upward slope of drugs in this class.”

The study reported that Medicaid spending on MS treatments was $453 million in 2011 and then nearly tripled to $1.32 billion in 2017.

Hartung says there was “nothing inherently different” about people under Medicaid compared to other sectors of the healthcare market.

Why didn’t that generic make more of a dent in slowing that rise?

Hartung says the biggest reason is that Copaxone continues to be used more than its cheaper generic alternatives.

That’s likely because of what he says was a commonly used strategy by drug companies ahead of a generic medication entering the market.

Ahead of the generic’s release, Hartung says, the manufacturer of Copaxone released a slightly different version of the drug that required a higher dose but fewer overall injections.

The dose went from 20 milligrams to 40 milligrams ahead of the FDA approval of a 20-milligram generic, says Bari Talente, executive vice president of advocacy at the National Multiple Sclerosis Society, which helped fund Hartung’s study.

That made it more difficult to substitute a generic at pharmacies.

“A significant number of users switched to the 40-milligram dose, so they stayed on the brand version when the first generic for the 20-milligram dose came out,” Talente told Healthline.

“It really had a big impact on reducing the penetration of the generic drug,” Hartung said.

Another generic alternative to Copaxone was approved by the FDA in 2017.

However, Talente notes that generics can still be expensive and have other barriers to access that can reduce incentives to switch to them.

She notes the Copaxone generics entered the market 15 to 20 percent lower than the brand-name drug’s price.

“It is commonly believed that it takes three to five generics per brand to see a substantial reduction in price, and we have not gotten to that number in MS,” she said.

In the survey released this week, more than 80 percent of respondents said that MS drug prices are “unreasonable,” and that the federal government should do more to control costs.

Talente says those actions could mean limiting prices for drugs that have already been on the market “for a considerable time.”

She also points to limiting the use of “specialty tiers,” which is when more of the cost of a drug, including a generic in some cases, is passed on to consumers in the form of coinsurance payments. That means the consumer pays a higher percentage of the drug’s price themselves.

Another potential solution, Talente notes, is limiting out-of-pocket costs for prescription drugs under Medicare, an issue some lawmakers are working to address.

Continually escalating prices have created a significant barrier to treatment and forced higher costs and increased stress for individuals and families, Talente says.

“People with MS are paying the price financially, physically, and emotionally for high drug prices,” she said.

Written by Matt Berger on January 16, 2020 — Fact checked by Sony Salzman